Healthcare Provider Details

I. General information

NPI: 1508363656
Provider Name (Legal Business Name): MICHAELA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 LAKESIDE HILLS PLZ STE 101
OMAHA NE
68130-2390
US

IV. Provider business mailing address

17021 LAKESIDE HILLS PLZ STE 101
OMAHA NE
68130-2390
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-1617
  • Fax:
Mailing address:
  • Phone: 402-934-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: